Patient Group Direction
for the supply of
LEVONORGESTREL
1500 microgram tablets
by Community Pharmacists
Valid from:
Expiry date:
PGD Reference Number
Version 1.2
Adapted from NHS Bristol, NHS North Somerset and NHS South Gloucestershire Patient Group
Directions for the supply of Progesterone Only Emergency Contraception (POEC) levonorgestrel
1500 micrograms by Community Pharmacists
Page 1 of 16
Patient Group Direction (PGD) for the supply of LEVONORGESTREL
BY COMMUNITY PHARMACIST
Authorisation details:
Name and Job Title
Written by
Rachel Britton
Senior Prescribing Advisor
North Somerset CCG
Reviewed by
Helen Wilkinson
South Gloucestershire CCG
Signature
Date
This patient group direction has been approved on behalf of Bristol Council by:
Name and Job Title
Signature
Date
Doctor
Pharmacist
Governance
Lead
This patient group direction has been approved on behalf of North Somerset Council by:
Name and Job Title
Doctor
Signature
Date
Dr Mary Backhouse
Chief Clinical Officer
NHS North Somerset CCG
Debbie Campbell
Head of Medicines
Management
Becky Pollard
Public Health
Director of Public Health
Representative
North Somerset Council
Pharmacist
This patient group direction has been approved on behalf of South Gloucestershire Council by:
Name and Job Title
Signature
Date
Doctor
Mel Green
Adapted from NHS Bristol, NHS North Somerset and NHS South Gloucestershire Patient Group
Pharmacist
of Medicines
Directions Head
for the supply
of Progesterone Only Emergency Contraception (POEC) levonorgestrel
1500 micrograms by Community Pharmacists
Management
Page 2 of 16
Public Health
Representative
Patient Group Direction (PGD) for the supply of Levonorgestrel
This patient group direction (PGD) is a specific written instruction for the supply of levonorgestrel
to groups of patients within the areas covered by Bristol City Council, North Somerset Council and
South Gloucestershire Council.
The majority of clinical care should be provided on an individual basis. The supply of medicines
under Patient Group Directions should be reserved for those limited situations where this offers an
advantage for patient care (without compromising patient safety) and where it is consistent with
appropriate professional relationships and accountability.
Staff Characteristics

Pharmacist registered with the GPhC who has
undertaken relevant training as specified by the
commissioner of the service.

Has undertaken appropriate training to carry out clinical
assessment of client who requires treatment according
to the indications listed in the PGD, including use of the
Fraser guidelines.

Has undertaken appropriate training for working under
patient group directions for the supply and administration
of medicines

Has undertaken training appropriate to this PGD with
one of the three local authorities that this PGD covers.

Pharmacist should be familiar with the information on
levonorgestrel in the current BNF

All registered Pharmacists are professionally
accountable for their practice in accordance with the
GPhC. In the exercise of professional accountability
there is a requirement to maintain and improve their
professional knowledge and competence.
THE PHARMACIST MUST BE AUTHORISED BY NAME,
UNDER THE CURRENT VERSION OF THIS PGD
BEFORE WORKING ACCORDING TO IT
Adapted from NHS Bristol, NHS North Somerset and NHS South Gloucestershire Patient Group
Directions for the supply of Progesterone Only Emergency Contraception (POEC) levonorgestrel
1500 micrograms by Community Pharmacists
Page 3 of 16
Clinical Details
Indication
Inclusion criteria
Emergency contraception in females presenting within 72
hours of unprotected or inadequately protected sexual
intercourse. (UPSI)
Any female aged up to and including 24 years who
presents within 72 hours of UPSI and is at risk of
pregnancy (refer to further information section for reasons
why UPSI may have occurred)
Any female aged up to and including 24 years who
presents within 72 hours of UPSI and is at risk of
pregnancy who has received treatment with progestogen
only emergency contraception (POEC) for this episode of
UPSI and vomiting has occurred within 3 hours of taking
the tablet (SPC recommendation)
Young persons under age 16 should be competent under
Lord Fraser guidelines (or have treatment consent from a
carer with parental responsibility)
Clinical Details
Exclusion criteria
 Aged 25 years or over
 This episode of UPSI occurred more than 72 hours ago
 Known hypersensitivity to levonorgestrel or any ingredient
contained in the product.
 Galactose intolerance, the Lapp lactase deficiency or
glucose-galactose malabsorption. This product contains
lactose.
 Pregnancy or suspected pregnancy e.g. menstrual
bleeding overdue or UPSI in the same cycle >72 hours
previously and no emergency contraception used. If the
menstrual cycle is late but a full sexual history and/or
negative pregnancy test has been performed at the correct
interval (3 weeks post penultimate episode of UPSI) and
pregnancy has been excluded, then EHC may be given
under this PGD.
 Less than 21 days post partum
 Non-active or active acute porphyria (see current BNF for
more detail)
 Unexplained or unusual menstrual bleeding
 Acute severe liver disease
 Acute episode of Inflammatory Bowel Disease or Crohns
Disease. These conditions may affect the absorption of
POEC. Women whose disease is active should be advised
that insertion of an IUD would be the most effective
emergency contraception for them and referred
accordingly
 Two known previous episodes of supply of emergency
Adapted from NHS Bristol, NHS North Somerset and NHS South Gloucestershire Patient Group
Directions for the supply of Progesterone Only Emergency Contraception (POEC) levonorgestrel
1500 micrograms by Community Pharmacists
Page 4 of 16




Cautions and
further information
Management of
excluded patients
contraception within this menstrual cycle
No informed consent for treatment provided
The patient wishes to see a doctor.Taking selegiline,
ciclosporin, tizanidine or ulipristal (see section on
interacting drugs)
Current breast cancer
If UPSI occurred in the 12 hours following a treatment
dose of levonorgestrel progesterone only emergency
contraception(POEC). (The FSRH advises that if further
UPSI occurs within 12 hours of a dose of POEC, further
POEC treatment is not required.)
 Emergency post-coital intrauterine device (IUD) should
always be considered as a more effective alternative when
emergency contraception is required
 If under 13 years of age, follow local safeguarding policy
 If individual vomits within 3hours from ingestion, a repeat
dose may be given
 UPSI may have occurred as a result of any of the
following. The Additional notes on page 13 contains
further information to assist pharmacists assessing the
clinical need for POEC treatment
- No contraception used
- Barrier method failure e.g. slipped or split condoms,
diaphragm or cap inserted incorrectly or dislodged during
intercourse or found to be torn/damaged or removed too
early.
- Prolonged oral contraceptive pill or patch or ring free
interval including vomiting or diarrhoea due to medication
and/or illness leading to a prolonged contraceptive pill or
patch or ring free interval
- Complete or partial expulsion of an intrauterine
contraceptive device (IUCD) including mid-cycle IUCD
removals
- Late or missed Depo-Provera contraceptive injection. i.e.
last injection administered more than 14 weeks ago.
Discuss reasons for exclusion
Refer patient to a GP or the sexual health clinic as appropriate
(see page 15) for further discussion and treatment
If more than 72 hours but less than 120 hours (5 days) since
the latest episode of UPSI alternative methods that should be
discussed with the woman include:
1. Intrauterine contraceptive device (IUCD) can be inserted up
to 120 hours after the first episode of unprotected sexual
intercourse or within 5 days of the earliest expected date of
Adapted from NHS Bristol, NHS North Somerset and NHS South Gloucestershire Patient Group
Directions for the supply of Progesterone Only Emergency Contraception (POEC) levonorgestrel
1500 micrograms by Community Pharmacists
Page 5 of 16
ovulation. Refer to the local sexual health clinic or a GP with
emergency coil fitting services
2. Efficacy of levonorgestrel 1500 micrograms has been
demonstrated up to 96 hours after UPSI and may be supplied
by a GP or local sexual health service.
3. Ulipristal acetate (ellaOne®) is licensed for use up to 120
hours following UPSI. This is not available on PGD and
therefore will require referral to the local sexual health service
or a GP.
Document reason for exclusion in client’s record including any
advice given, and suggested referral destination
Action for patients
not wishing to
receive care under
this PGD
Refer to local sexual health service or their usual GP
Document treatment declined in client’s record including the
reason for declining treatment if known, any advice given
included suggested referral destination
Drug Details
Name, form &
strength of
medicine
Legal classification
Levonorgestrel 1500 microgram tablets
Route/Method
Oral
Dosage
One tablet to be taken as a single dose as soon as possible
and no later than 72 hours after UPSI. (dose can be repeated
if vomiting occurs within 2 hours of first dose – see inclusion
criteria.)
POM-Prescription Only Medication
Two tablets to be taken as a single dose as soon as possible,
and not later than 72 hours after UPSI for women taking liver
enzyme inducing drugs or taking liver inducing enzymes in the
last 28 days if they are ineligible or do not wish to have an
intrauterine emergency method (dose can be repeated if
vomiting occurs within 2 hours of first dose – see inclusion
criteria)
Maximum treatment
period
Duration of
treatment
Quantity to
supply/administer
Treatment for two separate episodes of UPSI may be supplied
in each menstrual cycle and repeated use of POEC in one
menstrual cycle is supported by FSRH.
Stat dose to be consumed on the premises at the time of
consultation and supervised by the pharmacist
1 x 1500 microgram tablet
Or
Adapted from NHS Bristol, NHS North Somerset and NHS South Gloucestershire Patient Group
Directions for the supply of Progesterone Only Emergency Contraception (POEC) levonorgestrel
1500 micrograms by Community Pharmacists
Page 6 of 16
Obtaining supplies
Side effects
2 x 1500 microgram tablet for women taking liver enzyme
inducing drugs or taking liver inducing enzymes in the last 28
days
Community pharmacists operating this PGD use their
pharmacy supplies and are reimbursed at Drug Tariff price
The patient should be provided with advice about side effects.
In particular both written and verbal advice should be given
about vomited tablets
Levonorgestrel is generally well tolerated, but the patient may
experience the following:
 Very Common (>1/10)
Bleeding not related to menses, headache, nausea, low
abdominal pain, fatigue
 Common (>1/100, <1/10)
Vomiting, delay of bleeding >7 days, irregular bleeding and
spotting, dizziness, diarrhoea, breast tenderness
 Very rare (<1/10,000)
Rash, urticarial, pruritus, face oedema
Bleeding patterns may be temporarily disturbed, but most
women will have their next menstrual period within 7 days of
the expected time.
See current BNF and Summary of Product Characteristics for
full list of potential side effects.
Any adverse event that may be attributable to the POEC
should be documented in the patients clinical notes
Any adverse event that may be attributable to the POEC
should be reported following local incident reporting
procedures.
Any serious adverse event that may be attributable to the
POEC should be reported to the Medicines and Healthcare
products Regulatory Agency (MHRA) using the yellow card
scheme www.yellowcard.gov.uk
If vomiting occurs within two hours of taking the tablets, a
second dose will be required as soon as possible, see PGD
inclusion criteria.
Adapted from NHS Bristol, NHS North Somerset and NHS South Gloucestershire Patient Group
Directions for the supply of Progesterone Only Emergency Contraception (POEC) levonorgestrel
1500 micrograms by Community Pharmacists
Page 7 of 16
Drug Details
Interactions
Enzyme-inducing drugs reduce efficacy of POEC
Enzyme-inducing drugs reduce efficacy of POEC, so an
emergency copper-IUD would be preferable as it is the only
contraceptive method not affected by enzyme inducing
drugs. If copper-IUD is declined or while awaiting copperIUD fitting, a double dose of POEC should be given where
the woman is currently taking or has used enzyme inducing
drugs in the last 28 days. (Note: this double dose is an
unlicensed dose, but recommended by the FSRH in these
situations)
The following list of enzyme inducing drugs is derived from
the FSRH guideline ‘Drug Interactions with Hormonal
Contraception’ Jan 2012
Anticonvulsants Carbamazepine, Eslicarbazepine,
Oxcarbazepine, Phenobarbital, Phenytoin, Primidone,
Rufinamide, Topiramate
Anti-infectives Rifabutin, Rifampicin
Anti-viral treatments Ritonavir, Ritonavir-boosted
atazanavir, Ritonavir-boosted tipranavir, Ritonavir-boosted
saquinavir, all other ritonavir boosted protease inhibitors
(darunavir, nelfinavir, fosamprenavir, lopinavir) Efavirenz,
Nevirapine.
Others St Johns Wort (Hypericum perforatum), Bosentan,
Modafinil, Aprepitant, Sugammadex
Potential Drug Interactions
Cyclosporin – metabolism may be inhibited leading to
potential toxicity. Discuss with patients GP.
Anticoagulants – Warfarin and phenindiones effect may be
unpredictably altered. Advise INR check witin 7 days and
inform patients GP.
Selegiline – Selegiline levels may increase. Avoid
concomitant use. Discuss with patients GP.
Tizanidine – progestogens possibly increase plasma
concentration of tizanidine potentially leading to toxicity.
Avoid concomitant use. Discuss with patients GP.
Ulipristal – Contraceptive effect of progestogens possibly
reduced by ulipristal thus POEC may be ineffective. Seek
local sexual health service advice regarding suitable
Adapted from NHS Bristol, NHS North Somerset and NHS South Gloucestershire Patient Group
Directions for the supply of Progesterone Only Emergency Contraception (POEC) levonorgestrel
1500 micrograms by Community Pharmacists
Page 8 of 16
treatment options for the client.
Sugammadex – Administration of a bolus dose of
sugammadex is considered to be equivalent to one missed
daily dose of oral contraceptive steroids (either combined
or progestogen-only).
Disease interactions
Severe malabsorption syndromes – such as Crohn’s
disease, or removal of sections of intestines might impair
the absorption and the efficacy of levonorgestrel –advise
patient to seek advice regarding treatment with IUCD from
the local sexual health service or a GP with emergency coil
fitting service.
Current breast cancer – Advise patients of possible
disease interaction and the availability of alternative
treatment with emergency IUCD fitting.
The above list of drug interactions is not exhaustive. For
full interaction information please refer to a current version
of the BNF or Summary of Product Characteristics.
Information and advice
to be given to the
patient before
treatment is provided
 Inform clients that the IUCD is the preferred first line
treatment for all suitable individuals due to its low
documented failure rates. (This is a recommendation
from the FSRH).
 The pregnancy risk from a single act of intercourse is
highest (between 20-30%) in the days just before and
just after ovulation. Counting the first day of menstrual
bleeding as day 1, the pregnancy risk is low before day
7 and after day 17 inclusive in a 28-day cycle.
 Failure rates – data suggests that levonorgestrel POEC
is effective up to 96 hours and that delay in treatment
up to this time did not appear to affect efficacy
 Give client a copy of the manufacturers patient
information leaflet and the FPA leaflet on emergency
contraception – discuss as required especially any
difference in missed pill advice between the
manufacturer’s PIL and the FPA leaflets (developed
in conjunction with FSRH)
 Explain treatment and administration including advice
if vomiting occurs within two hours of taking the tablets
 Explain levonorgestrel mode of action – not known:
Probably prevents ovulation or affects tubal motility and
uterine lining
 The patient should be provided with advice about side
effects. In particular both written and verbal advice
should be given about what to do if vomiting occurs
within 2 hours of treatment
Adapted from NHS Bristol, NHS North Somerset and NHS South Gloucestershire Patient Group
Directions for the supply of Progesterone Only Emergency Contraception (POEC) levonorgestrel
1500 micrograms by Community Pharmacists
Page 9 of 16
 Use of levonorgestrel 1500 micrograms beyond 72
hours and up to 96 hours (4 days) – if referring clients
for this then the client should be aware that an IUCD is
more effective than levonorgestrel 1500 micrograms in
preventing pregnancy, particularly after 96 hours
 Advise client that she could still become pregnant. Her
period may arrive earlier or heavier than normal and
stress that this supply only treats this episode of UPSI.
If menstrual periods are delayed by more than 7 days or
is lighter than usual or she is concerned about changes
to her period, the client should be advised to have a
pregnancy test and seek medical advice from her GP or
local sexual health service.
 There is no guarantee of a normal outcome to any
pregnancy. However there is no evidence of EHC
causing birth defects if it fails.
 The possibility of an ectopic pregnancy should be
considered particularly in women with a previous
ectopic pregnancy, fallopian tube surgery or pelvic
inflammatory disease. Inform women to seek medical
advice if there is any moderate to severe lower
abdominal pain after taking levonorgestrel.
 Advise the practice of abstinence or careful use of
barrier method until onset of the next period or the
OCP/contraceptive patches are effective again, discuss
future contraceptive need and give information pack
that contains free condoms.
 Patient should be advised to make a follow up
appointment with her GP or local sexual health service
as soon as is practical to ensure that the method has
worked and to discuss on-going contraception.
 The client should be advised on continuation of regular
contraceptives.
 As part of raising awareness around sexually
transmitted infections and to increase Chlamydia
screening uptake, all clients presenting for
levonorgestrel 1500 micrograms should be informed
that POEC does not protect against sexually transmitted
infections and should be offered a Chlamydia screening
kit and advised how to submit it for testing.
Adapted from NHS Bristol, NHS North Somerset and NHS South Gloucestershire Patient Group
Directions for the supply of Progesterone Only Emergency Contraception (POEC) levonorgestrel
1500 micrograms by Community Pharmacists
Page 10 of 16
Records and Follow Up
Records/audit trail
Record the following in clients electronic pharmacy
record:
 Client name
 Client date of birth
 Medical history
 Drug history
 Manufacturer, brand, batch number, expiry date
 Dose supplied
 Date supplied
 Time(s) of supply
 Name of staff member who made supply
 Informed consent received/ given (and if not given by
client by whom and relationship to client)
 Details of any adverse reactions reported and actions
taken
 Fraser rules assessment if under 16
Note: It is strongly recommended that the client
takes the dose of levonorgestrel at the time of the
consultation. If this is not the case, the reason why
should be recorded in the clients record.
Follow up
Advise a follow up appointment with their GP or local
sexual health service in 3 to 4 weeks to ensure that the
method has worked.
If the patient does not have a period within 3 to 4 weeks
of taking emergency contraception, or their period is
unusually light, short or painful, or they have abdominal
pain, they should take an early morning sample of urine
with them to that appointment.
Patient should be advised to contact their GP or local
sexual health service at any time to discuss on-going
contraception.
In addition to offering a Chlamydia screening kit to each
client, if a sexually transmitted infection is suspected,
investigate or refer to the patients GP or local sexual
health service.
Adapted from NHS Bristol, NHS North Somerset and NHS South Gloucestershire Patient Group
Directions for the supply of Progesterone Only Emergency Contraception (POEC) levonorgestrel
1500 micrograms by Community Pharmacists
Page 11 of 16
References used for this PGD

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
Levonelle-1500 microgram tablet, Bayer plc, SPC – accessed via the eMC
www.medicines.org.uk SPC last revised 27.11.12
Evra SPC – accessed via the eMC www.medicines.org.uk SPC last revised 22.1.14
British National Formulary – accessed online www.bnf.org/bnf/index/htm
Guillebaud, J. 2009. Contraception your questions answered Fifth edition. Churchill
Livingstone: Edinburgh
FFPRHC Members Enquiry Response 985 9/3/2005 Are there any CI to using
levonelle twice within 1 cycle for women under 16?
Family Planning Association website –
www.fpa.org.uk/helpandadvice/contraception/combinedpill#forgetting-the-pill
Faculty of Sexual and Reproductive Healthcare (2009) UK Medical Eligibility Criteria
for Contraceptive Use: www.fsrh.org.uk/pdfs/UKMEC2009.pdf
Faculty of Sexual and Reproductive Healthcare (2009) Guidance on Progesterone
only Pills: www.ffprhc.org.uk/pdfs/CEUGuidanceProgesteroneOnlyPill09.pdf
Faculty of Sexual and Reproductive Healthcare (2009) Guidance on progestogen only
injectable contraception
www.ffprhc.org.uk/pdfs/CEUGuidanceProgestogenOnlyInjectables09.pdf
Faculty of Sexual and Reproductive Healthcare (2011) Drug Interactions with
hormonal contraception
www.ffprhc.org.uk/pdfs/CEUGuidanceDrugInteractionsHormonal.pdf
Faculty of Sexual and Reproductive Healthcare (2010) Antiepileptic drugs and
contraception: CEU statement January 2010
www.fsrh.org/pdfs/CEUStatementADC0110.pdf
Faculty of Sexual and Reproductive Healthcare (2011) Missed Pill recommendations
CEU Statement www.ffprhc.org.uk/pdfs/CEUStatementMissedPills.pdf
Faculty of Sexual and Reproductive Healthcare (2012) Emergency Contraception CEU
Statement www.fsrh.org/pdfs/CEUGuidanceEmergencyContraception11.pdf
Faculty of Sexual and Reproductive Healthcare (2010) Quick starting contraception.
Clinical Effectiveness Unit
www.fsrh.org/pdfs/CEUGuidanceQuickStartingContraception.pdf
Adapted from NHS Bristol, NHS North Somerset and NHS South Gloucestershire Patient Group
Directions for the supply of Progesterone Only Emergency Contraception (POEC) levonorgestrel
1500 micrograms by Community Pharmacists
Page 12 of 16
Additional notes
The licensed indication for Levonelle – 1500 is as emergency contraception within 72
hours of unprotected sexual intercourse or failure of a contraceptive method.
1. According to the SPC:
 Levonelle-1500 is not recommended in children and very limited data are
available in women under 16 years of age
 Repeated administration within a menstrual cycle is not advisable because of
the possibility of disturbance of the cycle.
 If vomiting occurs within three hours of taking the tablet, another tablet should
be taken immediately
2. According to the SPC for depot medroxyprogesterone acetate injection, EHC may
still be required if the depot is delayed and the interval between injections exceeds 12
weeks and 5 days (89 days in total). However, based on current best practice
recommendations from the FSRH this PGD supports the view that EHC will not be
required unless the interval between depot injections is more than 14 weeks (98
days)
3. The licenses for combined oral contraceptives (COCs) state that additional
measures should be taken if the COC is taken more than 12 hours late, for
progestogen only pills (POPs) this is an additional 7 days of contraceptive cover if the
pills are late, the latest guidance (May 2011) from the FSRH on missed pills give
different guidance based on the number and when the tablets were missed. This PGD
operates the FSRH guidance.
http://www.ffprhc.org.uk/pdfs/archive/ContraceptionProductLicence.pdf
(July 2005)
http://www.ffprhc.org.uk/pdfs/CEUStatementMissedPills.pdf
(May 2011)
Adapted from NHS Bristol, NHS North Somerset and NHS South Gloucestershire Patient Group
Directions for the supply of Progesterone Only Emergency Contraception (POEC) levonorgestrel
1500 micrograms by Community Pharmacists
Page 13 of 16
Safeguarding/ Child Protection considerations
 Any patient under 16 must be deemed to be Fraser competent, and Child
Protection procedures must be followed.
 Should a client accessing this service be identified as having potential
safeguarding issues, the pharmacist should discuss their concerns with a
safeguarding lead to be advised on any appropriate actions. (see contact details
below)
Bristol
North Somerset
See the following website for contact details:
www.4ypbristol.co.uk/for-professionals/wpcontent/uploads/sites/3/2013/09/E_Safeguarding-ContactDetails_Jan2014.pdf
Designated nurse for safeguarding and looked after
children
Tel: 01275 546758
Mob: 07795403153
Email: sarah.tyndall@northsomersetccg.nhs.uk
Named Doctor for child protection
Tel: 01934 515878
Mob: 07595361522
Email: mike.pimm@gp-L81643.nhs.uk
South Gloucestershire
Safeguarding Lead Designated Nurse
Tel: 07824608656
Email: sgccgsafeguarding.children@nhs.net
OR Telephone NBT switchboard (Mon-Fri, 9am-5pm):
0117 970 1212 and ask for the Child Protection Doctor on
call
(Out of Hours, telephone UHB switchboard: 0117 923
0000, and ask for the Consultant Community Paediatrician
on call)
Adapted from NHS Bristol, NHS North Somerset and NHS South Gloucestershire Patient Group
Directions for the supply of Progesterone Only Emergency Contraception (POEC) levonorgestrel
1500 micrograms by Community Pharmacists
Page 14 of 16
Contact Details for Sexual Health Services
Bristol
Bristol Sexual Health Service
Tel: 0117 342 6900
Brook Young People’s Clinic
Tel: 0117 929 0090
Also visit www.4ypbristol.co.uk for the most up to date list
of sexual heath services in Bristol, including GP practices,
sexual health clinics and school based services.
North Somerset
No Worries Service (under 21)
Tel: 01934 425718
Weston Integrated Sexual Health (WISH)
Tel: 01934 881234
Also see: www.shnsomerset.co.uk
South Gloucestershire
Contraceptive and Sexual Health Service (CASH)
Tel: 0117 342 6900
No Worries
Tel: 0117 342 6900
Worth Talking About
0800 28 29 30
Also see: http://no-worries.youthunltd.com
Adapted from NHS Bristol, NHS North Somerset and NHS South Gloucestershire Patient Group
Directions for the supply of Progesterone Only Emergency Contraception (POEC) levonorgestrel
1500 micrograms by Community Pharmacists
Page 15 of 16
Individual Authorisation
I have read and understood the Patient Group Direction and agree to supply
this medicine only in accordance with this PGD.
PGDs DO NOT REMOVE INHERENT PROFESSIONAL OBLIGATIONS OR
ACCOUNTABILITY.
It is the responsibility of each professional to practice only within the
bounds of their own competence and in accordance with their own code
of professional conduct.
Name of Pharmacist
Signature
Date
Adapted from NHS Bristol, NHS North Somerset and NHS South Gloucestershire Patient Group
Directions for the supply of Progesterone Only Emergency Contraception (POEC) levonorgestrel
1500 micrograms by Community Pharmacists
Page 16 of 16